FROM THE MAYO CLINIC

Racing heart may call for a lifetime of medication

May 07, 2006|By Tribune Media Services

Q. I had an episode of atrial fibrillation in 2004 and again in December 2005. Both were controlled in a few hours with medication. My doctor wants me to stay on medication. Is this necessary as a preventive? I'd prefer not to take medication the rest of my life.

--Arizona

A. Most people with atrial fibrillation, a condition where the heart races or beats out of sync, require lifelong medications to manage the condition and reduce associated health risks.

Though atrial fibrillation isn't life-threatening, it poses serious health risks. People with atrial fibrillation are about five times more likely to have a stroke than those without the condition. High blood pressure, diabetes, a history of stroke or being over 70 make the stroke risk even higher. Atrial fibrillation can weaken the heart, leading to heart failure, a condition where your heart can't circulate enough blood to meet your body's need. Quality of life can suffer, with symptoms such as weakness, lightheadedness, shortness of breath and chest pain.

The medications your doctor recommends will depend on your symptoms and situation. Warfarin (Coumadin), a blood-thinning medication, helps reduce the risk of stroke. Most people also require medications to slow the heart rate, such as digoxin (Lanoxin), a beta blocker or a calcium-channel blocker.

Anti-arrhythmic medications can be used to keep the heart in normal rhythm. The most commonly used drugs are flecainide (Tambocor), propafenone (Rythmol), sotalol (Betapace), dofetilide (Tikosyn) and amiodarone (Cordarone, Pacerone). These medications are effective for about 60 percent of patients with atrial fibrillation. About 20 percent have troublesome side effects; 1 to 3 percent experience life-threatening complications.

If your symptoms aren't bothersome, your physician might recommend warfarin and a medication to control the heart rate. For people with severe symptoms, anti-arrhythmic drugs may help improve their quality of life. When patients are younger than 70 and have no other health concerns, aspirin can suffice instead of warfarin.

When medications don't control atrial fibrillation, patients have other treatment options, including procedures to shock the heart into a normal rhythm or to block the source of the electrical misfiring in the heart. Pacemakers help some patients too.

Even if your heart returns to a normal rhythm, it's important to work with your doctor on an ongoing treatment plan. That's because there's a high likelihood that the condition will recur. About one-third of the time, patients aren't aware of fibrillation episodes.